A variety of problems exist with conventional methods of assessing and managing job or work-related musculoskeletal injuries in the Federal Government DOD (Department of Defense. The DOD process of assessing and managing work-related injuries is based on a model developed in the 1960's. Multiple federal agencies, such as injury compensation, occupational medical service (OMS), defense commissary association (DeCA), defense logistics agency (DLA), and defense reutilization and marketing service (DRMS), can have different regulations for accepting and managing work-related injuries. Also, poor communication between injured workers, employers, authorizing agencies and physicians can add increased costs and delays to the compensation and recovery periods. Each involved party has a different perspective on the injury assessment and management process. Injured employees may view the process with suspicion and uncertainty concerning their physical and financial future. They are concerned that they may not get the best care or they are fearful that if they return to work they will be injured worse.
Further, relatively few private physicians understand the federal DOD injury assessment and management processes. They become unhappy with the bureaucracy, paper work, and authorization processes that require extra federally trained staff. Also, statistics show that medical school graduates are weak in musculoskeletal knowledge. 1998 statistics reported that although roughly 25% of visits to primary care physicians are for musculoskeletal problems, typically less than 3% of the undergraduate medical school curriculum is spent on musculoskeletal medicine. (THE PHYSICIAN AND SPORTSMEDICINE—VOL 27—no. 3—March 98.) Statistics as recent as 2004 show that graduates still exit medical school without sufficient core knowledge in the musculoskeletal area.
Still further, employers may view injured employees with suspicion. Employers worry about the rising cost and lost time from work. They also can become skeptical about the claim and motivation of the physician and employee. The different agencies may have concerns about all parties involved. These agencies lack ongoing local training for medical providers, each agency seems to have their own set of rules that are not easy to find or interpret, and they are difficult to reach on the phone.
The musculoskeletal injury area has evidence of needing focused attention. For instance out of 11 million work-related injuries per year, the majority are sprain and strains. Back and neck injuries represent over 25% of presenting diagnoses. Physicians use a periodically updated international coding database containing international classification of diseases (ICD) for defining patient diagnoses before treatment. The ICD coding standard (currently ICD9) provides a numeric code and a brief text description of a medical problem a physician identifies in each patient. The ICD coding standard provides a vehicle for somewhat consistent application of diagnosis values. However, its organization structure is insufficient for preventing informational disconnects between even slightly disparate diagnoses between physicians who evaluate the same patient for a malady and for facilitating computational linkage between specific diagnosis values and more generalized diagnosis values.
As an example, one big problem with the current federal injury process takes into account integrated care models developed by the DOD and algorithms to justify authorizations for treatments. If the diagnosis for injury presented for payment to the DOD does not match the initial diagnosis assigned by the first treating medical provider, payment is denied and more justification is required. This process delays care from several perspectives. The employee is not authorized to receive further care, the medical provider is denied payment, the case is essentially placed on-hold, and in the worst case scenario, the employee could be responsible for the medical bill. If an employee is taken out of work, he could possibly stay out on pay while the case is on hold.
Accordingly there is an unaddressed need in the industry to address the aforementioned and other deficiencies and inadequacies.